Andean Digital Health Policy, Telemedicine, and Sanitary Interoperability for Rural Zones: A Framework Design and Ex-Ante Economic Simulation of PASDIT

Abstract Territorial health inequity in the Andean Community (CAN), comprising Bolivia, Colombia, Ecuador, and Peru, constitutes a persistent geospatial market failure with measurable consequences for human capital accumulation, household welfare, and regional economic productivity. Specialist physician density in rural zones averages 7.5 times lower than in urban centers, while annual out-of-pocket (OOP) health expenditures per rural patient exceed USD 500 (purchasing power parity), frequently constituting a catastrophic household expenditure event. This article presents the conceptual design framework and ex-ante economic simulation of the Andean Digital Health, Telemedicine, and Sanitary Interoperability Policy for Rural Zones (PASDIT), a proposed regional integration instrument aimed at reducing barriers to healthcare access across territories through digital transformation and cross-border interoperability. A policy-cycle framework is applied alongside a partial equilibrium simulation model calibrated against OECD (2023), PAHO (2022), and IDB (2020) benchmarks. Three policy alternatives are systematically compared through a multi-criteria decision analysis (MCDA) and cost-effectiveness analysis (CEA). Sensitivity analysis is applied across conservative and optimistic coverage scenarios. The proposed PASDIT model projects, under conservative assumptions, a 50% reduction in average specialist wait times, an 81% decrease in rural household OOP health expenditure, a 25% reduction in avoidable hospitalizations, and a fiscal cost per additional patient reached of USD 138, representing an 84% cost advantage over physical hospital expansion alternatives. These are simulation estimates derived from calibrated benchmarks, not empirically measured outcomes. PASDIT offers a federally structured, cost-effective policy architecture for addressing geospatial market failures in Andean healthcare. Its federated interoperability model and modular design render it methodologically transferable to other lower-middle-income regional integration blocs facing analogous territorial access challenges. This paper contributes a replicable ex-ante evaluation methodology for digital health policy design in regional governance contexts. Keywords: Ex-Ante Policy Simulation; Telemedicine; Digital Health Governance; Health Interoperability; Rural Healthcare Access; Regional Health Integration; Lower-Middle-Income Countries